Rationale for classifications of craniocerebral combat wounds inflicted by modern weapons

BACKGROUND: During the Great Patriotic War, craniocerebral combat wounds were classified. Currently, gunshot wounds demonstrate a greater variety, severity, and extent of tissue injury in craniocerebral regions on the periphery of the wound canal compared to wounds from past wars. Furthermore, advanced diagnostic techniques that can identify previously undescribed cerebral wound canals, which were generally considered fatal, are now available. Thus, new classification systems for craniocerebral gunshot wounds are required. AIM: The work aimed to broaden the fundamental classification of craniocerebral gunshot wounds by including the current clinical and anatomical findings, facilitating a more comprehensive clinical diagnosis. METHODS: The assessment findings and treatment outcomes of two groups of wounded patients were analyzed. Group 1 included 127 patients with craniocerebral gunshot wounds who had been treated in a military hospital during the Soviet–Afghan War. Group 2 comprised 67 wounded participants of modern armed conflicts who were treated at the Neurosurgery Clinic of the Kirov Military Medical Academy. RESULTS: A contemporary clinical and anatomical classification of craniocerebral gunshot wounds was developed. This classification includes posterior cranial fossa (the cerebellum and brainstem) wounds. The proposed classification offers a framework for more accurate triaging based on injury severity. This facilitates decision-making for surgical prioritization, including in scenarios involving mass admissions. Primary attention should be given to patients with wound canal passing through the cortex and white matter of the brain. Generally, the more convex trajectory of the wound canal is associated with less severe brain injury. Surgical procedures are performed after stabilization of vital signs in patients with wound canals passing through the first-level (e.g., subcortical structures, ventricles, and brainstem) and second-level (e.g., cortex and cerebellar hemispheres) brain structures. The prognosis of these wounded patients largely depends on the severity and extent of damage to vital brain structures. CONCLUSION: The developed clinical and anatomical classification is beneficial for elucidating the nature of craniocerebral gunshot wounds, facilitating a targeted triage of admitted wounded patients, ensuring surgical prioritization, and predicting the prognosis and outcome of craniocerebral wounds.